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Aneurysm of saphenous vein bypass graft to coronary artery
Aneurysm of saphenous vein bypass graft to coronary artery A few cases of aneurysmal dilatation of autogenous vein grafts to peripheral arteries have been reported. However, to our knowledge, no case of this complication in coronary artery vein bypass grafts have been found. We are presenting a case of a vein graft aneurysm which appeared 6 months postoperatively. The patient had had an aortic valve replacement and a vein bypass graft to the right coronary artery.
Mohammad Riahi, M.D., C. Mark Vasu, M.D., Luis A. Tomatis, M.D., Ralph J. Schlosser, M.D., and Glenn Zimmermann, M.D., Grand Rapids, Mich.
Autogenous vein bypass graft of the coronary arteries has been the procedure of choice for revascularization of the myocardium and is being used with increasing frequency in many institutions throughout the world. Aneurysmal dilatation of the vein bypass graft is a very rare complication. In a 10 year review of 295 cases of autogenous vein bypass grafts of the peripheral arteries in 1967, Darling, Linton, and Razzuk' did not find any evidence of this complication. In 1972, Carlos and colleagues reported a case of aneurysm of a vein bypass graft of the carotid artery, 2 and in 1973, de la Rocha and associates" found atherosclerosis and aneurysm formation in a vein bypass graft of the femoropopliteal artery. To our knowledge, no instances of aneurysm formation of a vein bypass graft of the coronary arteries has yet been reported. The purpose of this article is to present what seems to be the first such complication of coronary artery surgery. Case report J. E., 40-year-old white man, underwent openheart surgery for severe aortic insufficiency at From the Department of Thoracic and Cardiovascular Surgery, Butterworth Hospital, Grand Rapids, Mich. Received for publication April 18, 1975. Address for reprints: Dr. M. Riahi, 21 Michigan, N .E., Grand Rapids, Mich. 49502.
358
Butterworth Hospital in September, 1971. The aortic valve was replaced with a Starr-Edwards prosthesis. Two years after the initial operation the patient was rehospitalized for severe aortic regurgitation. Fluoroscopy revealed detachment of 40 per cent of the circumference of the prosthesis from the aortic annulus. On Aug. 22, 1973, the patient was reoperated upon and the old prosthesis was replaced with a new one. Due to the extreme friability and fragility of the tissue in the aortic annulus, the prosthesis was placed in position by mattress sutures which were brought out through the aortic wall and tied over the Teflon pledget. During the course of the procedure the origin of the right coronary artery was lacerated and, due to the extreme friability of the tissue, the laceration could not be repaired. As the vessel was a dominant right coronary artery, an aorta-coronary artery vein bypass graft was performed. The patient had an excellent recovery period and was discharged to his home. Six months later a follow-up chest x-ray film showed a well-circumscribed lesion adjacent and to the right side of the aortic knob. Aortography showed this lesion to be an aneurysm of the vein graft (Fig. I) approximately I Vi inches in diameter. On March 20, 1974, the patient was operated upon for the third time. An aneurysmal dilatation of the vein graft was found approximately 1.5 em. distal to the aortic anastomosis. Prior to excision of the aneurysm, the anastomosis of the vein graft to the aorta was inspected through an aortotomy. It was found to be widely open and showed no evidence of an anastomotic false aneurysm. The aneurysm was partially filled by laminated old blood clots and measured I Vi inches in
Volume 70 Number 2 August, 1975
Aneurysm of vein graft
359
Fig. 1. Aortogram showed this lesion to be an aneurysm of the vein graft approximately 1112 inches in diameter. diameter. After removal of the blood clots the endothelium was smooth and showed no evidence of atheromatous changes. The pathology report on the surgical specimen confirmed the diagnosis of aneurysm. Distal to the aneurysm, the vein graft was thrombosed and occluded. The patient had a satisfactory postoperative course and was discharged in good condition.
Summary
Aneurysm of a vein graft of the coronary artery may be a rare complication in myocardial revascularization. A case of this complication, apparently the first ever reported, has been presented.
We would like to thank Larry Treece, C.C.P., for the photograph used in this article. REFERENCES Darling, C. R., Linton, R. R., and Razzuk, M. A.: Saphenous Vein Bypass Grafts for Femoropopliteal Occlusive Disease: A Reappraisal, Surgery 61: 31, 1967. 2 Carrasquilla, C., and Weaver, A. W.: Aneurysm of a Saphenous Vein Graft to the Common Carotid Artery, Vase. Surg. 6: 66, 1972. 3 De la Rocha, A. G., Peixota, R. S., and Baird, R. J.: Atherosclerosis and Aneurysm Formation in a Saphenous Vein-Graft, Br. J. Surg. 60: 72, 1973.
Mohammad Riahi, M.D., C. Mark Vasu, M.D., Luis A. Tomatis, M.D., Ralph J. Schlosser, M.D., and Glenn Zimmermann, M.D., Grand Rapids, Mich.
Autogenous vein bypass graft of the coronary arteries has been the procedure of choice for revascularization of the myocardium and is being used with increasing frequency in many institutions throughout the world. Aneurysmal dilatation of the vein bypass graft is a very rare complication. In a 10 year review of 295 cases of autogenous vein bypass grafts of the peripheral arteries in 1967, Darling, Linton, and Razzuk' did not find any evidence of this complication. In 1972, Carlos and colleagues reported a case of aneurysm of a vein bypass graft of the carotid artery, 2 and in 1973, de la Rocha and associates" found atherosclerosis and aneurysm formation in a vein bypass graft of the femoropopliteal artery. To our knowledge, no instances of aneurysm formation of a vein bypass graft of the coronary arteries has yet been reported. The purpose of this article is to present what seems to be the first such complication of coronary artery surgery. Case report J. E., 40-year-old white man, underwent openheart surgery for severe aortic insufficiency at From the Department of Thoracic and Cardiovascular Surgery, Butterworth Hospital, Grand Rapids, Mich. Received for publication April 18, 1975. Address for reprints: Dr. M. Riahi, 21 Michigan, N .E., Grand Rapids, Mich. 49502.
358
Butterworth Hospital in September, 1971. The aortic valve was replaced with a Starr-Edwards prosthesis. Two years after the initial operation the patient was rehospitalized for severe aortic regurgitation. Fluoroscopy revealed detachment of 40 per cent of the circumference of the prosthesis from the aortic annulus. On Aug. 22, 1973, the patient was reoperated upon and the old prosthesis was replaced with a new one. Due to the extreme friability and fragility of the tissue in the aortic annulus, the prosthesis was placed in position by mattress sutures which were brought out through the aortic wall and tied over the Teflon pledget. During the course of the procedure the origin of the right coronary artery was lacerated and, due to the extreme friability of the tissue, the laceration could not be repaired. As the vessel was a dominant right coronary artery, an aorta-coronary artery vein bypass graft was performed. The patient had an excellent recovery period and was discharged to his home. Six months later a follow-up chest x-ray film showed a well-circumscribed lesion adjacent and to the right side of the aortic knob. Aortography showed this lesion to be an aneurysm of the vein graft (Fig. I) approximately I Vi inches in diameter. On March 20, 1974, the patient was operated upon for the third time. An aneurysmal dilatation of the vein graft was found approximately 1.5 em. distal to the aortic anastomosis. Prior to excision of the aneurysm, the anastomosis of the vein graft to the aorta was inspected through an aortotomy. It was found to be widely open and showed no evidence of an anastomotic false aneurysm. The aneurysm was partially filled by laminated old blood clots and measured I Vi inches in
Volume 70 Number 2 August, 1975
Aneurysm of vein graft
359
Fig. 1. Aortogram showed this lesion to be an aneurysm of the vein graft approximately 1112 inches in diameter. diameter. After removal of the blood clots the endothelium was smooth and showed no evidence of atheromatous changes. The pathology report on the surgical specimen confirmed the diagnosis of aneurysm. Distal to the aneurysm, the vein graft was thrombosed and occluded. The patient had a satisfactory postoperative course and was discharged in good condition.
Summary
Aneurysm of a vein graft of the coronary artery may be a rare complication in myocardial revascularization. A case of this complication, apparently the first ever reported, has been presented.
We would like to thank Larry Treece, C.C.P., for the photograph used in this article. REFERENCES Darling, C. R., Linton, R. R., and Razzuk, M. A.: Saphenous Vein Bypass Grafts for Femoropopliteal Occlusive Disease: A Reappraisal, Surgery 61: 31, 1967. 2 Carrasquilla, C., and Weaver, A. W.: Aneurysm of a Saphenous Vein Graft to the Common Carotid Artery, Vase. Surg. 6: 66, 1972. 3 De la Rocha, A. G., Peixota, R. S., and Baird, R. J.: Atherosclerosis and Aneurysm Formation in a Saphenous Vein-Graft, Br. J. Surg. 60: 72, 1973.